The legislative reform of the 118 territorial emergency system is “urgent and necessary. It can certainly be considered among the most important health reforms of the last 30 years”. Mario Balzanelli, president of Sis 118, underlines this, explaining to Adnkronos Salute why the legislative reform of 118 is needed and how to build it, while taking stock of the state of health of the territorial emergency system.
“118 is the time-dependent life-saving system that arrives, within a few minutes, at the place where someone may be in imminent danger of death, in any part of the territory, in any context, even the most hostile and impervious – states Balzanelli – and ensures, at any time of day or night, 24 hours a day and 365 days/year, medical assistance: in concrete terms, the 118 System rescues countless human lives from death which, without our intervention, in a significant percentage, would not arrive alive in hospital. Especially after the recent, dramatic lesson taught by the pandemic, the reform of the 118 System can be considered among the most important health reforms of the last 30 years: citizens know this very well and recognize it every day. Let us come in in their homes – he remarks – wherever there is need, when sudden tragedy looms, we and no one else in our place”.
But can we still talk about 118 or is it more appropriate to talk about 112? “It is essential, today more than ever, to clarify that we need to talk about 118 much more than 112 – responds Balzanelli – The European Union foresees that national emergency numbers will not be abolished at all, as is happening today in 60% of Member countries of the Union, as strongly recommended by the European guidelines of ERC (European Resuscitation Council) in 2021, to avoid possible catastrophic waste of time related to the ‘double passage’ between operating centers (that of 112 and that of 118), particularly when it comes to a health emergency – he warns – therefore of imminent danger of losing one’s life. In the case of sudden cardiac arrest, for example, every minute that passes determines the loss of truly significant percentages of returning to life. Not surprisingly, the ‘The EU expresses itself in terms of an ’emergency number’ rather than a ‘single’ number, but, recently, with regulation 2023/444, launched on 16 December 2022, to avoid delays and discrepancies in the functional paths relating to 112 , clarified that the citizen user’s call must be immediately forwarded to the most appropriate operations center to resolve the problem. This – in the event of a health emergency – can only coincide, if we want to gain as much time as possible, with direct access of the call to the 118 Operations Center. Time is life!”
“An alternative – proposes Balzanelli – would be to allow those who called 112 to simply press a button on the telephone, without any additional cost to the community, to be immediately directed to the 118 operations centre. This will need to be verified and compare, preliminarily, the data collected from the implementation of the two different models, as well as evaluate the quality perceived by citizens through the multiple documented experiences”.
Full integration between the local emergency system and the hospital system is necessary. What is the position of Sis118? “The word integration, from the Treccani vocabulary, means completion and not merging, annexation or invasion. The 118 territorial emergency system is recognized by the legislator as part of territorial medicine, as it is included in the health district, and as it is a macrostructure at the size of objectively high management complexity deserves – explains Balzanelli – the legal recognition of the highest level of complexity, i.e. that of the departmental operational unit of the territory, with the Operations Center considered a center of responsibility and not a mere call centre, at provincial level, as sanctioned by the Presidential Decree of 27/3/1992, on a par with the configuration of all the state institutions involved in emergency management, such as the Prefecture, Police Headquarters, police, Carabinieri, Fire Brigade, which are all configured at provincial level”.
Balzanelli then notes that “the 118 territorial emergency system is already fully integrated with the hospital system because it ensures the network routes envisaged for time-dependent acute pathologies, transports critical patients directly to the ultra-specialist operating units and because in numerous territories , with dedicated personnel and vehicles, also ensures secondary emergency transport (i.e. from hospital to hospital), in addition to that of blood and organs. In this sense, integration is a dynamic and qualifying goal to be continuously improved, but it must be intended exclusively as a functional integration of the clinical, diagnostic and therapeutic path, ensuring the critically ill patient a unitary management philosophy. In no way, however, do we believe the term integration can and should be understood as shared management of top roles of responsibility and staff resources with the hospital network. Full management autonomy must be maintained. Otherwise, it would mean giving up a reliable, qualified and effective system, which has held up and guaranteed, despite the many critical issues and the permanent state of abandonment by the legislator and the various decision-makers at regional level, the conduction and management of the territorial emergency in the nation for the last 30 years.”
The 118 doctors are disappearing, they are in massive flight, in almost all regions. Question of contracts? “The citizen does not care at all whether the person who comes to his home at dawn to help him for an acute pulmonary edema is an affiliated doctor or an employed doctor. Whatever type of contract is decided, at a legislative level, to identify for the 118 doctor – replies Balzanelli – it must be attractive, much more than what happens today, precisely by virtue of its highly demanding and objectively risky character, in the presence of known and peculiar environmental and biological risks. The local emergency doctor is a precious reality that goes further valued and towards which the due maximum respect and recognition of merit must be shown. With regards to knowledge, skills and abilities, Sis118, as a scientific society, deems it essential to intensify and expand, also in collaboration with universities, permanent and applicants and related training”.
What role does the reform designed by Sis118 envisage for nurses? “The 118 local emergency nurse is, together with the doctor, the indispensable management pillar of the advanced support of the vital functions of the critically ill patient and the linchpin of the professionalizing activity in the Operations Room and – Balzanelli remarks – must not be replaced, in the role of an operations center operator from other figures. We believe, in this regard, that the standard of an advanced station with a doctor and nurse on board for every 60,000 inhabitants should be established at a legislative level”. Furthermore, Sis118 has “for years been urging the highest institutions of the State, the first scientific society among all, to ensure that the professional profile of the driver-rescuer is launched as soon as possible on a legislative level, with the deserved and definitive recognition not only of its key role thereof, but also of the peculiar skills regulated in highly specialized training courses”.
And what is the role of technology in the coming 118? “Sis118 deems it essential to launch a ‘connected’ 118 System, ensuring citizens who find themselves in imminent danger of life can benefit from all the most advanced and qualitative dynamics, from telemedicine to telemonitoring, from teleconsultation to artificial intelligence, to diagnostic support and advice”.